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Flapan A D - - 1997
The effect on heart rate variability of adding digoxin to a diuretic and ACE inhibitor was studied in patients with chronic stable cardiac failure. Digoxin was found to increase heart rate variability, especially those measures of heart rate variability thought to represent parasympathetic activity. The withdrawal of digoxin led to ...
Spencer K T - - 1997
Congestive heart failure (CHF) with normal left ventricular systolic function and abnormal diastolic performance is a common clinical entity. Typically, signs and symptoms are indistinguishable from those of heart failure related to systolic dysfunction. Coronary artery disease, systemic hypertension, and aging are all associated with diastolic CHF. Diagnosis depends on ...
Iliceto S - - 1997
Left ventricular dysfunction is the most common cause of congestive heart failure. Thus, treating or preventing left ventricular dysfunction represents an important therapeutic goal. The use of calcium antagonists in the treatment of left ventricular dysfunction or congestive heart failure has been proposed for many years now, mainly because of ...
Sasayama S - - 1997
Depression of myocardial contractility plays an important role in the development of heart failure; therefore, intensive interest and passion have been generated to develop cardiotonic agents to improve the contractile function of the failing heart. Inotropic agents that increase cyclic AMP, either by increasing its synthesis or reducing its degradation, ...
Cohn J N - - 1997
Heart failure is a complex syndrome; therapy should be aimed at the independent goals of prolonging life and of improving symptoms and quality of life. Some therapies are effective in achieving one goal but not the other. Short-term symptomatic relief may relate to alleviation of haemodynamic abnormalities and of congestion, ...
Sorrentino M J - - 1997
The goals of therapy for congestive heart failure (CHF) are to improve quality of life and to prolong it. Improvement in patients with CHF can only be realized, however, if a multidisciplinary healthcare team can provide effective management in both the inpatient and outpatient settings. Inhibition of compensatory mechanisms that ...
Levin T N - - 1997
Immediate management of congestive heart failure (CHF) is directed at reduction of preload and afterload and augmentation of forward blood flow and cardiac output. A variety of pharmacologic agents (e.g., diuretics, positive inotropic agents, vasodilators, vasopressors) are available for use in the intensive care unit. For patients in cardiogenic shock ...
Katz S - - 1997
Continuing high morbidity and mortality have spurred an ongoing search for new therapeutic agents for patients with congestive heart failure. Calcium antagonists (CAs) have been under active investigation in patients with heart failure since their introduction into clinical medicine, because their anti-ischemic and vasodilator properties were thought to be of ...
Iliceto S - - 1997
In a poll of European cardiologists, one of the most popular of the given definitions of heart failure centres on the abnormality of ventricular function. However, opinion remains divided on the necessity of a distinction between diastolic and systolic heart failure, as it does on the value and procedures of ...
Bales A C - - 1997
Congestive heart failure (CHF) is a progressive disease with multiple possible causes. Systolic heart failure, defined as contractile failure of the myocardium leading to a reduced ejection fraction, is the most common type. Systolic heart failure may result from coronary artery disease, hypertension, a metabolic disorder, infection, or an infiltrative ...
Pool P E - - 1997
Progressive heart disease after the onset of left ventricular dysfunction has typically been attributed to hemodynamic factors. As left ventricular function declines, decreased cardiac output and tissue hypoperfusion lead to compensatory increases in afterload, preload, and heart rate. The purpose of these compensatory responses is to increase cardiac output and ...
Kubo S H - - 1997
There has been an intensive search for safe and clinically effective inotropic agents for use as adjunctive therapy in patients with advanced heart failure. Pimobendan is a benzimidazole-pyridazinone derivative with calcium-sensitizing properties that increases myocardial contractile force without increasing intracellular calcium. This review summarizes the data from five controlled, randomized ...
West J A - - 1997
The effectiveness of heart failure management in clinical practice is limited by physicians' suboptimal utilization of effective medications, patients' poor adherence to dietary sodium limitation and optimal drug therapy, and the lack of systematic monitoring of patients after hospitalization. The present study evaluated the feasibility and safety of MULTIFIT, a ...
Sütsch G - - 1997
In recent years, evidence from various animals experiments has accumulated that emphasizes the role of endothelin-1 in the pathophysiology of several cardiovascular diseases, including congestive heart failure. The recent advent of potent antagonists of this system now allows the assessment of the involvement of endothelin-1 in the maintenance of vascular ...
Lewis B S - - 1996
Calcium antagonists have a useful role in the management of patients with cardiac disease, producing coronary and systemic vasodilatation and an additional possibly beneficial effect on ventricular diastolic function. On the other hand, the myocardial depressant effect of the first-generation drugs and the abrupt changes in blood pressure, with neurohormonal ...
Konstam M A - - 1996
Since their development, calcium channel blocking agents have stimulated interest in their potential benefit for a variety of cardiovascular disorders, including heart failure. The rationale for the potential benefit of calcium channel blockers in heart failure is multi-factorial, including vasodilation, correction of perturbed diastolic relaxation, anti-ischemic action, and potential for ...
Javaheri S - - 1996
Despite recent advances in its treatment, congestive heart failure associated with depressed left ventricular function continues to be associated with excess morbidity and mortality. Multiple factors may contribute to the progressively declining course of heart failure. Nocturnal arterial oxyhemoglobin desaturation caused by sleep-disordered breathing could be a contributing factor, particularly ...
Bradley T D - - 1996
Despite advances in medical therapy of congestive heart failure (CHF), morbidity and mortality for this disorder remain high. One factor that could contribute to the poor prognosis of CHF is Cheyne-Stokes respiration with central sleep apnea (CSR-CSA). This breathing disorder is a frequent complication of CHF, where it is associated ...
Colucci W S - - 1996
We tested the hypothesis that carvedilol inhibits clinical progression in patients with mildly symptomatic heart failure due to left ventricular (LV) systolic dysfunction. Patients (n = 366) who had mildly symptomatic heart failure with an LV ejection fraction (LVEF) < or = 0.35, had minimal functional impairment (defined as the ...
Conti C R - - 1996
Despite recent analyses questioning the safety of calcium antagonists, evidence and clinical practice strongly support a major role for these drugs in the management of many cardiovascular diseases such as arrhythmia, vascular spasm, hypertension, diastolic dysfunction, stable angina, and myocardial infarction. These agents are a heterogeneous class of drugs with ...
Hillis G S - - 1996
OBJECTIVE: To assess the investigation and treatment of cardiac failure in 1995 and to compare this with management in 1992. DESIGN: Retrospective consecutive case study. SETTING: University teaching hospital. SUBJECTS: All patients (n = 265) discharged from Aberdeen Royal Infirmary in the first quarter (January 1-31 March) of 1995 with ...
Cleland J G - - 1996
Although there is undoubtedly a link between ventricular dysfunction and heart failure the interrelationship is complex. Most patients with left ventricular dysfunction die before progression to heart failure. Heart failure is not preceded by a period of chronic left ventricular dysfunction for the large number of patients who develop heart ...
Futterman L G - - 1996
Significant strides have been made in the medical therapy of chronic CHF in the past two decades. Treatment has evolved from therapy based on the older concepts of the pathophysiology of CHF to evidence-guided therapy supported by results of major landmark studies that expand the understanding of the pathophysiology. Attenuation ...
Eichhorn E J - - 1996
Myocardial failure has been considered to be an irreversible and progressive process characterized by ventricular enlargement, chamber geometric alterations, and diminished pump performance. However, more recent evidence has suggested that certain types of medical therapy may lead to retardation and even reversal of the cardiomyopathic process. In the failing heart, ...
Forker A D - - 1996
The conceptual framework for treatment of congestive heart failure has changed dramatically in the past 30 years. The 1950s and 1960s were characterized by manipulation of the left ventricular function curve by digitalis and diuretics. The 1970s focused on relief of symptoms by afterload reduction with vasodilators. Then stimulation of ...
Furnary A P - - 1996
OBJECTIVES: The purpose of this study was to prospectively assess the effect of dynamic cardiomyoplasty in patients with symptomatic chronic heart failure. BACKGROUND: Since the first procedure was performed in 1985, dynamic cardiomyoplasty has been developed for use in patients with chronic heart failure. The aging population in developed countries ...
King D - - 1996
Heart failure is common in the elderly and is associated with a significant morbidity and mortality. It accounts for about 5% of adult medical admissions and the expenditure of 1% of the total National Health Service budget. Clinical presentation in old age may be with the classical symptoms of heart ...
Zannad F - - 1996
AGE-RELATED CARDIOVASCULAR CHANGES: Age-related changes in vascular structure and function may contribute to isolated systolic hypertension and target-organ damage. These include cardiac hypertrophy, systolic as well as diastolic dysfunction, congestive heart failure, coronary artery disease, cardiac arrhythmias, cerebrovascular diseases, peripheral vascular diseases and renal insufficiency. POTENTIAL ADVANTAGES OF CALCIUM ANTAGONISTS ...
van Veldhuisen D J - - 1996
Digoxin has been a controversial drug since its introduction >200 years ago. Although its efficacy in patients with heart failure and atrial fibrillation is clear, its value in patients with heart failure and sinus rhythm has often been questioned. In the 1980s, reports of some large-scale trials indicated that digoxin, ...
Tormey V - - 1996
Despite advances in the pharmacological management of cardiac failure, some patients remain refractory to this therapy. However, improved understanding of the physiology and technique of peritoneal dialysis has recently allowed ambulatory peritoneal ultrafiltration to be applied to the treatment of patients with intractable heart failure. We report the management of ...
Dracup K - - 1996
Although heart failure secondary to left ventricular systolic dysfunction remains a serious disease with high morbidity and mortality, pharmacologic intervention has been shown to be associated with improved survival and a decreased number of hospitalizations. Primary-care providers must be aware of the potential benefits of recent therapeutic advances and current ...
Seta Y - - 1996
Although the development and progression of heart failure have traditionally been viewed as hemodynamic disorders, there is now an increasing awareness that the syndrome of heart failure cannot be simply and/or precisely defined solely in hemodynamic terms. The inability of the so-called hemodynamic hypothesis to explain the progression of heart ...
Benedict C R - - 1996
BACKGROUND: Elevated plasma neurohormonal levels are associated with increased mortality rates in patients with symptomatic heart failure. A previous Studies of Left Ventricular Dysfunction (SOLVD) trial suggested that neurohumoral activation precedes the development of symptoms as demonstrated by increased neurohormonal levels in patients with asymptomatic left ventricular dysfunction. However, the ...
Sigurdsson A - - 1996
Chronic heart failure is a disabling and lethal disorder with high incidence and prevalence in Western societies. Treatment with angiotensin-converting enzyme (ACE) inhibitors and heart transplantations diminish both mortality and morbidity, although both still remain high. Increased understanding of some of the pathophysiologic mechanisms involved in the development of left ...
Mair F S - - 1996
Heart failure is associated with high rates of morbidity and mortality. Because heart failure is difficult to diagnose accurately on the basis of the history and physical examination alone, It is vital that clinical evaluation such as echocardiography be used to confirm the diagnosis. In addition, it is important to ...
Cash L A - - 1996
Heart failure from diastolic dysfunction is a clinical syndrome similar to, but distinct from, failure from systolic dysfunction. Because the standard cardiac diagnostic tools may not be helpful, the advance practice nurse and physician collaborate on the diagnosis. Interventions are aimed toward improving diastolic filling and reducing hemodynamic compromise for ...
Galbraith A - - 1996
Heart failure is still not well treated and the published information concerning treatment options has been slow in filtering through to general practitioners. Once a diagnosis of heart failure is made, treatment should begin with an angiotensin converting inhibitor. The dose should be increased relatively quickly. Diuretics and digoxin can ...
Ott P - - 1996
It is now well established that digoxin is an effective drug for the treatment of heart failure. Since treatment with angiotensin-converting enzyme (ACE) inhibitors reduces mortality in congestive heart failure, digoxin should be added to ACE inhibitors in patients with moderate or severe heart failure. The beneficial effects of digoxin ...
Gavras I - - 1996
This is a brief overview of various mechanisms activated by angiotensin converting enzyme (ACE) inhibition that affect the anatomy and function of the heart. The benefits of ACE inhibition include not only a reduction in blood pressure but also improved insulin responsiveness, prevention of potassium loss, diminished myocardial oxygen demand, ...
Shipley J B - - 1996
Milrinone (Inocor-Sanofi-Winthrop) represents a second generation phosphodiesterase inhibitor currently approved for intravenous administration in the treatment of decompensated congestive heart failure. By inhibiting Type III phosphodiesterase, milrinone increases intracellular cyclic adenosine monophosphate. This results in a positive inotropic effect on the heart and vasodilatation in the periphery. The hemodynamic consequences ...
Cleland J G - - 1996
PURPOSE: Left ventricular hypertrophy (LVH) caused by systemic hypertension, myocardial infarction and congestive heart failure is associated with pathological changes in the structure of the heart, collectively described as remodelling (see part 1 of this review). The reversal of remodelling, termed cardioreparation, might restore cardiac structure and function towards normal, ...
Elkayam U - - 1996
Nitrates have been widely used for the treatment of patients with chronic congestive heart failure. Although the use of these drugs has not been evaluated by large-scale studies traditionally used for evaluation of new therapy, multiple studies over the years have demonstrated their favorable effects. Organic nitrates have been shown ...
Boden W E - - 1996
Therapy with angiotensin-converting enzyme inhibitors and nonselective vasodilators (hydralazine and isosorbide dinitrate) has become accepted treatment in patients with symptomatic, chronic congestive heart failure (CHF), and has been demonstrated in large clinical trials to ameliorate symptoms, improve exercise performance, and reduce cardiac mortality. Nevertheless, the management of patients with CHF ...
Elkayam U - - 1996
Organic nitrates have frequently been used for the treatment of patients with congestive heart failure (CHF). Nitrate tolerance has been identified as a major limitation of this therapy preventing a continuous effect. In the past several years, an effort has been made to develop strategies to prevent nitrate tolerance. Recent ...
Ruzumna P - - 1996
A significant subset of patients with chronic heart failure have preserved systolic function and their symptoms are attributable to left ventricular diastolic abnormalities. In the setting of diastolic heart failure, the cardiac chambers are nondilated and have normal contractility, but left ventricular filling is impaired. This impairment in diastolic filling ...
Wagoner L E - - 1996
Congestive heart failure is the final common pathway of diverse etiologies that result in impaired systolic and diastolic function, deleterious activation of neurohumoral pathways, and high morbidity and mortality. Many studies published in 1995 significantly added to our understanding of the pathophysiologies of heart failure at the cellular level. Because ...
Slatton M L - - 1996
Despite therapy with diuretics, digoxin, and angiotensin-converting enzyme inhibitors, congestive heart failure remains an important health problem with high mortality, and it is clear that new treatments for heart failure are needed. Evidence from basic research, animal studies, and clinical human trials indicates that high adrenergic tone in patients with ...
Packer M - - 1996
Although heart failure has been viewed primarily as a haemodynamic disorder, the development of pharmacologic agents that address the haemodynamic derangements has not proved to be a successful approach to its management. Consequently, attention in recent years has shifted to the development of neurohormonal antagonists in the hope that prolonged ...
Packer M - - 1996
During most of the last 50 years, physicians have viewed heart failure primarily as an oedematous disorder, in which fluid retention occurs because the heart cannot pump adequate quantities of blood to the kidneys. This conceptual model led to the successful utilization of diuretics for heart failure, but it failed ...
Dargie H J - - 1996
We review current knowledge on the true size of the clinical condition known as 'heart failure' in terms of epidemiological information and in relation to the true clinical burden. Population studies, together with data from physician and general practitioner records, reveal a range of estimated heart-failure prevalence of 1-10%. Estimated ...
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